Animal Bites (cont.)
Scott D Fell, DO, FAAEM
Jerry R. Balentine, DO, FACEP
Jerry R. Balentine, DO, FACEP
Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.
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Animal Bite Diagnosis
The doctor will assess the risk of infection, look for other injuries, and try to minimize any scarring or deformity from an animal bite. Additional questions will help clarify if the patient needs tetanus vaccination, and if there is a risk of rabies exposure.
Inspection: The wound will be thoroughly examined to look for any debris such as dirt, grass, teeth, clothing, or other objects that may have become embedded into the bite area. Leaving behind any of these would increase the risk for infections significantly. Sometimes the wound will be numbed with lidocaine to decrease pain while the doctor makes a complete inspection of the area. This is not always necessary and depends on the extent of the injury.
X-rays: The doctor may order X-rays to look for fractures of bones or to make sure nothing remains in the wound. Although certain objects such as metal always show up on X-ray, some objects such as dirt and grass do not usually appear. That's why careful inspection and washing out the wound are key to proper care. Despite best efforts, there is always a risk that foreign material will be missed and may be in the wound.
Irrigation: This is very important to preventing infection as it helps clean the wound of debris. Several techniques are used but the idea is the same. The health care professional will spray irrigation solution (usually saline solution or tap water) into the wound with either an irrigation device or a syringe (without the needle) in order to wash out anything that may contaminate the wound. Despite best efforts and intentions, infections can and still do occur in animal bites.
Debridement (tissue removal): Dog bites are noted for being crush type injuries. This will macerate and tear apart the skin and tissue in humans. The result is that skin tears often are not repairable because of the amount of damage or the significant crushing mechanism. These areas usually have either no blood supply to them or decreased blood supply and will not survive and are considered to be dead tissue that needs to be removed. The risk of infection increases significantly in these types of crush injuries.
Closure: Not all animal bites need to be or can be closed with stitches. Some wounds are sutured (stitched) immediately after they occur (this is referred to as primary closure). Some are repaired a few days later (referred to as delayed closure). Some animal bites are never sutured.
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